Suggestions for weaning patients with ARDS from VV ECMO*^¶

ARDS: acute respiratory distress syndrome; VV: venovenous; ECMO: extracorporeal membrane oxygenation; FiO₂: fraction of inspired oxygen; RR: respiratory rate; PEEP: positive end-expiratory pressure; ABG: arterial blood gas; PaCO₂: arterial partial pressure of carbon dioxide; PaO₂: arterial partial pressure of oxygen.
* Refer to UpToDate's content on extracorporeal membrane oxygenation.
¶ Note that there are patient-dependent and institution-dependent variations in weaning protocols. Most centers implement weaning protocols during daytime hours when clinicians with appropriate expertise are available.
Δ We maintain flows >2 L/minute at this stage to avoid formation of thrombi, unless additional heparin is administered.
◊ Refer to UpToDate's content on ventilator management strategies for adults with ARDS.
§ Some centers allow a PCO₂ >50 mmHg if renal function is intact, there by allowing compensation.
¥ It is important to have some ventilatory "reserve" in these parameters in case there are temporary periods of worsening (eg, during patient turning or sedation holidays).